Despite government efforts, 625,000 Indian children still use tobacco daily

The government's efforts have led to a reduction of 8.1 million smokers between 2009 and 2017.

Over 103 million adults and 625,000 children still smoke on a daily basis.

India needs to raise taxes further, crack down on illegal tobacco sales and do a better job of implementing the guidelines of the National Tobacco Control Program.

The WHO’s Global Adult Tobacco Survey estimated that the total number of smokers in India fell by 8.1 million between 2009 and 2017. Yet, 625,000 children still use tobacco in the country on a daily basis.

According to the Tobacco Atlas, a report compiled by the American Cancer Society and Vital Strategies,
103.6 million people in India over the age of 15 consumed tobacco every day as of 2015, 87% of which were men. The results indicate that over 20% of India’s male population smokes compared to 2% of its females.

Worse still, the report shows that the habit starts at a young age. Over half a million children between the age of 10 and 14 years also smoke on a daily basis. Nearly 70% of this figure is accounted for by boys, which indicates that the proportion of female smokers could increase in the future.

While the report maintains that there are fewer deaths from smoking in India in comparison to countries with similar levels of human development, around 13,452 men and 4,435 women die every week owing to smoking-related issues, amounting to 930,000 annual deaths. The direct health costs and indirect costs such as lost productivity were pegged at 1.8 trillion rupees.

India has cracked down on tobacco use in recent years. The government has implemented measures such as a graphic pictorial warning that covers 85% of the package, higher duties on cigarettes and a ban on smoking in educational institutions, government facilities and hospitals. It has also made anti-tobacco advertising spots, which are distinguished by their appallingly low production value, a regular fixture at the cinema and on television. So, despite efforts by various governments, more work remains to be done.

What can India do to further?

“There needs to be greater intervention at the ground level,” according to Dr Srinivas Ramaka, a noted cardiologist and tobacco control advocate. He says that the government has fallen short in implementing the guidelines of the
National Tobacco Control Program (NTCP). Under the guidelines, there should be a Tobacco Control Cell in hospitals at the district level, which offers counselling and medical services for patients who wish to quit smoking.

Srinivas also cited the sale of illegal forms of tobacco, noting that it was an issue for the police to address. Even though gutka (oral tobacco) is banned, his patients are often able to buy the harmful mixture for as low as Rs. 5 in “loose form”, he said.

India needs to do a better job of targeting bidis, which are hand-rolled cigarettes. Unlike most countries where cigarettes account for a high proportion of tobacco usage, branded cigarettes comprise only
11% of tobacco consumption in India, according to the Tobacco Institute of India.

Srinivas said that the government needs to provide bidi-rollers with alternative modes of employment through skill training programmes. Tobacco cultivators should also be incentivised to grow different crops that offer similar margins, as per NTCP guidelines.

Finally, taxes need to be raised on all forms of tobacco as the WHO states that this is one of the only proven ways to reduce tobacco consumption, especially among the poor, under its
MPOWER policy. The Tobacco Atlas estimates that only 26.5% of a tobacco product’s retail price in India is attributable to excise taxes. The WHO says that at least 70% of the price of a pack of cigarettes should be covered by taxes.

Being the second-largest consumer of tobacco in the world, India has the power to raise taxes on tobacco products further.